St Helens Borough Council: local authority assessment

St Helens Practice Model was launched in March 2024 as a framework to enable frontline staff to adopt a strength-based approach to Care Act 2014 assessments based on an understanding of trauma-informed practice, focusing on identifying and building on individual strengths and growing local networks of support, enabling people to manage their health and wellbeing and remain independent.

The first point of contact for any health and social care support in St Helens was via the Contact Cares service. The Contact Cares service was managed by the local authority’s integrated Place and Social Care Directorate, in partnership with colleagues in Mersey and West Lancashire Hospital Trust and Merseycare. They offered a broad range of services focusing on prevention and hospital discharge.

People told us they could easily access Contact Cares through multiple channels, including online and self-assessment options. The service was based at Whiston Hospital and acted as an integrated health and social care referral point, offering signposting, initial telephone assessments, appointment bookings, safeguarding referrals, and access to Mental Health Act 2007 assessments (including referrals to the UCR team). In addition, Contact Cares operated as the hospital discharge Transfer of Care Hub for Mersey West Lancashire Trust, processing all discharge referrals and liaising with support services to ensure smooth transitions including Care Act 2014 assessments.

Senior leaders explained how Contact Cares supported the local authority’s Home First strategy, offering planned assessments for short-term interventions, for example, visits from the falls team, occupational therapy assessments for basic equipment, or to support hospital discharges. In addition, St Helens had an Integrated Discharge Team (IDT) which was joint funded by St Helens Council and Mersey West Lancashire Trust who provided the clerical support.

People told us they felt their voices were heard throughout the Care Act 2014 assessment process. Their experience of care and support ensured their human rights were respected and protected, and they were involved throughout the decision-making process. The St Helen’s Practice model ensured their protected characteristics under the Equality Act 2010 were understood and were incorporated into care planning. Pathways and processes ensured people’s support was planned and co-ordinated across different agencies and services.

Staff and leaders explained Care Act 2014 assessments were completed by 4 teams: Contact Cares, the Working Age team, the Later Life team, and the Integrated Continuing Health Care (CHC) team. Staff told us Contact Cares was key to the local authority’s ability to allocate all new referrals and manage waiting list. Early intervention processes by the Contact Cares team ensured non-complex cases were not competing with complex cases for allocation, and timely short-term interventions supported the prevent, reduce, delay function of the service.

The Contact Cares service operated daily from 8am until 10pm, with an integrated UCR team as part of the initial response and an Emergency Duty Team (EDT) functioning outside these times. The St Helens EDT provided out-of-hours cover across adults and children services and was jointly commissioned with Halton local authority.

Staff and leaders told us the local authority had Care Act 2014 assessment teams who were competent to carry out these assessments. More complex cases were allocated to the Working Age Team (for people aged 18-67) or the Later Life Team (for people aged 67 and above). These teams worked with people in crisis or who required an assessment for longer-term services, with the CHC Team completing Mental Capacity Act 2005 (MCA) assessments and Deprivation of Liberty Safeguards (DoLS) assessments.

Senior leaders shared how the Working Age Team were a borough-wide service supporting adults of working age including those with mental health issues including an Approved Mental Health Practitioner (AMHP) service, physical disabilities, learning disabilities and autistic people. The Later Life Team were also a borough-wide service, supporting complex Care Act 2014 assessments and reviews for adults who had entered the care system in later life because of age-related disabilities, dementia, and other mental health issues.

Senior leaders told us Care Act 2014 Assessment and care planning arrangements were timely and up to date. The local authority maintained zero waiting lists for non-complex Care Act 2014 assessments, with all urgent Care Act 2014 assessments being allocated to the UCR team within 2 hours of initial contact. The target timescale for completion of more complex Care Act 2014 assessments, referred to the Working Age Team and the Later Life Team, was 4 weeks. Data provided by the local authority showed a median average waiting time of 3 weeks for more complex Care Act 2014 assessments.

Staff and leaders explained how annual reviews of Care Act 2014 assessments were similarly well managed, with data provided by the local authority showing there were 247 people waiting for a review of their care and support needs, meaning 12.43% of annual reviews were overdue as of December 2024. There was a median average waiting time of 30 days and a maximum waiting time of 50 days past the review due date. Reasons for waiting times included people being unavailable due to being away or in hospital at the time the annual review was due.

Senior leaders told us the local authority was acting to manage and reduce waiting times for assessment, care planning and reviews. The local authority had clear processes to reduce any risks to people's wellbeing, while they were waiting for a Care Act 2014 assessment. Risk assessments, weekly reviews, interim support arrangements and partnership working meant urgent needs were met in a timely manner and cases could be escalated if people’s needs changed.

Staff and leaders told us out-of-borough placements were reviewed and monitored by the Provider Development and Quality Monitoring Teams who liaised with provider services, families, and commissioners from other local authorities. Families could request unscheduled reviews if there were concerns or changes in need impacting on placements, and annual reviews took place in a timely manner. At the time of the assessment activity there was no waiting list for out-of-borough reviews.

St Helens had commissioned a provider to deliver an All-Age Carers service, with unpaid carers assessments, annual reviews, advice and information, respite, and peer support. The needs of unpaid carers were recognised as distinct from the person with care and support needs. Carers assessments, support plans and annual reviews for unpaid carers were undertaken separately to the people they were supporting.

Senior leaders told us the target timescale for completion of carers assessments was 10 working days, with data provided by the local authority showing a median average waiting time of 5 working days and a maximum waiting time of 15 working days (3 weeks). In December 2024 there were 12 people waiting for a carers assessment however all these assessments had been booked to take place by the end of December 2024 and planned with the carer’s consent. Data provided by the local authority showed a median average waiting time (past the due date) for annual reviews of carers assessments of 10 working days, with a maximum waiting time of 20 working days (4 weeks).

People told us unpaid carers assessments were proportionate, offering advice and signposting them to support services as well as accessing respite and contingency planning needs. Unpaid carers described having regular annual reviews, and being able to request further support at any time should their needs or situation change. Carers found out about and accessed unpaid carers support from various sources, for example via the local authority’s website, or by being told about the Carers Centre by friends, other carers and through contact with charities. Only a few people we spoke to told us they had been referred by local authority frontline teams, though staff and leaders told us frontline teams identified potential unpaid carers needs as part of the initial Care Act 2014 assessment and could offer joint assessments where this was appropriate. Partners also told us carers could be referred via Carer GP Champions based in GP surgeries as well as self-referring via telephone, web, email, or walk-in services.

Figures provided by the local authority showed 1,400 new carers were identified each year in St Helens, of which 200 were young carers. The 2021 census found 1.5% of residents aged 5 years to 18 years in St Helens reported providing up to 19 hours of unpaid care each week in 2021. According to St Helens Mental Health and Wellbeing Joint Strategic Needs Assessment (JSNA) 2023, young carers in St Helens could expect to spend a decade of their lives in this role. St Helens All-Age Carers Strategy (2023-2027) involved consultation with adult carers, young carers, and parent carers to ensure people’s lived experience was reflected in the strategy and support was available during the transition from children to adult carers.

National data provided by Survey of Adult Carers in England (SACE) in 2024 showed 49.43% of unpaid carers in St Helens accessed support groups or someone to talk to in confidence. This was tending towards a positive variation to the England average of 32.98%. National data also showed 48.62% of unpaid carers in St Helens were satisfied with social services, showing a positive variation compared to the England average of 36.83%.

People told us they were given help, advice, and information about how to access services, facilities, and other agencies for help with non-eligible care and support needs. St Helens and their partner organisations had commissioned a number of community-based services offering a range of support to meet the needs of local people.

Partners told us the local authority commissioned of a number of food support services, including food banks and community pantries providing discounted access to weekly food and home living essentials. Further support was available to help with the cost of living via Contact Cares, local community centres and libraries. For example, debt support services and fuel and energy support groups had been set up to offer advice and support.

Staff and leaders shared information about ‘Welcoming Spaces’ across the Borough. These welcoming spaces provided a safe place to meet, whilst providing community support to those with non-eligible needs, for example cultural support relating to hate crimes.

People also told us about Contact Cares signposting them to services via the Live Well Directory and the Supported Employment service, which promoted independence and enable people to take the next step towards work and training.

The Care Act 2014 set a minimum national eligibility criteria threshold for adult social care and support needs and unpaid carer support needs. The local authority’s framework for eligibility for care and support was timely, transparent, and consistently applied. The Assessment, Eligibility, Personal Budget & Support Planning Guidance, May 2024 set out the processes for eligibility decisions.

National data from the adult social care survey (ASCS) 2024 showed 51.08% of people did not buy any additional care or support privately or pay more to ‘top up’ their care and support. This was a significant negative variation to the average for England at 64.39% and meant a higher-than-average number of people were paying to meet their care and support needs.

Staff and leaders told us St Helens Council operated Quality Assurance Panels to oversee the appeals process for those contesting eligibility decisions. Data provided by the local authority showed there had been no formal appeals lodged in the last 12 months.

The local authority’s framework for assessing and charging adults for care and support was clear, transparent, and consistently applied. Decisions and outcomes were timely. People explained how they were notified of financial contributions, supported with completion of the self-assessment forms which included an online financial contribution calculator, and told how to appeal if they disagreed with the local authority’s decision.

Senior leaders explained there had been 2,164 referrals for financial assessments within the last twelve-months. There were no waiting times as assessments were assigned daily, with self-assessment paperwork sent out the same day. Data provided by the local authority showed of the 81 stage one adult social care complaints received in 2023-2024, 33% were relating to financial matters, all of which were resolved.

The local authority commissioned an external provider to deliver advocacy services and ensure timely, independent advocacy support was available to help people participate fully in care assessments and care planning processes. An advocate can help a person express their needs and wishes and weigh up and make decisions about the options available to them. They can help them find services, make sure correct procedures were followed and challenge decisions made by local authorities or other organisations.

People described positive outcomes when accessing advocacy services, with people being supported to make informed, meaningful decisions whilst having their rights protected and outcomes agreed which had positive impacts on their daily lives. However, feedback from partner organisations was mixed, with concerns about a lack of advocacy knowledge amongst frontline teams, including the local authority’s responsibility to refer for advocacy support when the person lacked capacity. Partners told us there was sometimes resistance shown by frontline teams to constructive challenge from advocates and people supporting decision making through Best Interest Meetings. Senior leaders told us advocacy drop-in sessions were in place for frontline staff to improve understanding of the process.